Reproductive and Sexual Health in the States: Two Steps Forward, Several Steps Back

By the end of March, 825 measures had been introduced in the 44 legislatures that have convened so far in 2010. Five legislatures (Mont., Nev., N.D., Ore. and Texas) do not meet this year, and North Carolina does not convene until May.

To date, seven new laws impacting reproductive health and rights have been enacted. Among the most noteworthy are measures:

requiring an abortion provider in Utah who performs an ultrasound before an abortion to show the woman the image and offer her the option of receiving a description of it;

requiring an abortion counselor in Utah to inform a woman seeking an abortion that the state’s counseling video is available online; allowing for an additional penalty for the murder of a pregnant woman in Wyoming; and

permitting a health care professional in Idaho to refuse to provide services related to abortion or family planning.

In addition to these laws, 49 other bills have been approved by at least one chamber of the legislature, and some interesting trends are beginning to emerge.

Treating Partners for STIs

In 2009, six states moved to expand access to STI testing, treatment and prevention by enacting legislation allowing a health care provider to prescribe STI treatment for a patient’s partner without having examined the partner. So far this year, legislators have introduced similar measures in seven states (Conn., Maine, Mo., Neb., Okla., R.I. and Wis.) to permit so-called “expedited partner treatment.” The enactment of legislation in Maine at the end of March brings to 15 the number of states with such provisions.

The new law in Maine allows partner treatment for all STIs, as would the bills pending in three states (Neb., Okla. and R.I.). The bills in the remaining three states would be more limited. The Connecticut and Missouri measures would permit treatment only for Chlamydia and gonorrhea. The Wisconsin bill, which has been approved by the Senate and is awaiting action in the Assembly, would permit treatment only for Chlamydia, gonorrhea and trichomoniasis.

Insurance Coverage of Abortion

Given the visibility of abortion in the national debate over health care reform, it is not surprising that the issue is also garnering widespread attention at the state level. Action at the state level is clustering into two distinct categories—coverage under insurance policies currently being written in the state and coverage in policies that will be offered through the insurance exchanges created under health care reform.

Measures have been introduced in three states (Kansas, N.H. and Okla.) that would restrict or prohibit insurance coverage of abortion under plans currently being written in the state. Bills pending in Kansas and Oklahoma would restrict coverage offered under all such plans. The measures in Kansas would permit abortion coverage only in cases of life endangerment, rape and incest; they would allow broader coverage only under riders purchased by individuals. Oklahoma currently permits abortion coverage beyond cases of life endangerment, rape or incest only through purchase of a rider. The pending legislation would ban coverage of all “elective” abortions without defining the term, potentially limiting coverage to cases of life endangerment; the rider option would be eliminated. Five states currently restrict insurance policies (see Restricting Insurance Coverage of Abortion).

Measures specifically targeting abortion coverage in plans offered to public employees are pending in five states (Ariz., Kansas, N.H., S.C. and W.Va.). The bill in Kansas would permit coverage only in cases of life endangerment, rape and incest; the Arizona measure would permit coverage in cases of life endangerment or possible “substantial and irreversible impairment of a major bodily function.” The bills in South Carolina (a state that currently restricts coverage to cases of life endangerment, rape and incest) and West Virginia would prohibit coverage of abortion with no exceptions. The South Carolina bill has been approved by the House and is pending in the Senate. Twelve states restrict abortion coverage for public employees (see Restricting Insurance Coverage of Abortion).

Measures introduced in four states (Iowa, Miss., Mo. and Tenn.) address the question of insurance coverage in the health exchanges that will eventually be established under the national health care reform legislation. Bills introduced in Missouri, Mississippi and Tennessee would block coverage in exchanges created by either the federal or state government. The Mississippi measure failed to receive committee approval by the deadline for action. The Missouri bill would allow coverage for abortion only if the woman’s life is at risk. The Tennessee measure would completely prohibit coverage of abortion. The Iowa measure would only allow abortion coverage when necessary to protect the woman’s life, if the coverage is purchased by the state via a “trust fund” that would be created as part of health reform.

Ultrasound Requirements for Women Obtaining an Abortion

So far this year, legislators have introduced 32 measures in 17 states seeking to involve or further incorporate ultrasound into abortion services. They range from bills that would require providers to offer information about ultrasound to those that would mandate not only that an ultrasound be performed, but also that the woman be shown the image.

Measures pending in 13 states would require abortion providers to offer some information or services related to ultrasound. Bills pending in nine states (Ala, Iowa, Ind., Kansas, Mass., Neb., N.J., N.Y. and S.C.) would require abortion providers to offer information related to ultrasound, and/or to provide the woman with information about where she can obtain the procedure. Bills in four of these states (Iowa, N.J., N.Y. and S.C.) as well as four others (Ill., Md., Mo. and W.Va.) would require an abortion provider to offer a woman seeking an abortion an ultrasound. Currently, eight states require verbal counseling or written materials to include information on accessing ultrasound services. Three states require that a woman be provided with the option to obtain an ultrasound (see Requirements for Ultrasound).

In March, a measure to add requirements for providers performing an ultrasound in preparation for an abortion was signed into law in Utah; a similar measure is awaiting action by the governor in West Virginia. The Utah measure requires providers to display the ultrasound image and to offer the woman the option of a verbal description. The West Virginia bill would require providers to offer the woman the option to view the image. With the addition of Utah, nine states currently regulate the performance of ultrasound when performed as part of preparation for an abortion (see Requirements for Ultrasound).

To date, legislators in 10 states (Alaska, Ala., Kansas, Ky., La., Okla., R.I., S.C., Va. and W.Va.) have introduced measures to mandate the performance of an ultrasound prior to any abortion procedure; two of these bills have seen significant action. In Virginia, a measure passed the House but was defeated in the Senate. And in Oklahoma, a bill is pending in the House after having been approved by the Senate. The Oklahoma bill would require that the provider display and describe the image to the woman, although she would be entitled to “avert” her eyes; it is virtually identical to legislation enacted in the state in 2008 that was struck down by the court on procedural grounds. Three states require the performance of an ultrasound on any woman seeking an abortion, and require the provider to offer the woman the opportunity to view the image (see Requirements for Ultrasound).